二维斑点追踪技术评价川崎病患儿左心室收缩功能

目的运用二维斑点追踪技术评价川崎病（KD）患儿不同时期左心室收缩期节段及整体峰值应变及应变率变化，并分析左心室应变及应变率与常规超声心动图参数及实验室指标的相关性。 方法选取2016年1至12月兰州大学第二医院儿童医院急性期诊断为KD住院患儿50例，其中18例患儿合并冠状动脉扩张，32例患儿冠状动脉正常。选取同期以心脏杂音来该院门诊就诊，但超声心动图检查结果正常的患儿30例作为对照组。运用常规超声心动图及二维斑点追踪技术分别于急性期（静脉注射免疫球蛋白前，IVIG前）、亚急性期（IVIG后1周）及恢复期（IVIG后8周）获取常规超声心动图参数及收缩期左心室整体峰值纵向应变（GLS）及应变率（GLSR）、收缩期整体峰值环向应变（GCS）及应变率（GCSR）、收缩期左心室各节段收缩期峰值纵向、环向应变及应变率，并于急性期获取实验室参数，包括C反应蛋白（CRP）浓度、红细胞沉降率（ESR）、白细胞（WBC）计数、血小板（PLT）计数、丙氨酸转氨酶（ALT）浓度、天冬氨酸转氨酶（AST）浓度。比较不同时期KD患儿与对照组患儿常规超声心动图参数、左心室局部及整体应变及应变率；比较冠状动脉扩张组与冠状动脉正常组KD患儿常规超声心动图参数、左心室局部及整体应变及应变率；分析急性期KD患儿左心室GLS与常规超声心动图参数及实验室指标的相关性。 结果与对照组患儿比较，KD组患儿急性期左心室质量指数（LVMI）、左冠状动脉（LCA）内径、右冠状动脉（RCA）内径均升高，GLS、基底段纵向应变、中间段纵向应变、GCS及基底段环向应变均降低，且差异均有统计学意义（t=4.823、4.123、3.018、3.982、5.135、4.753、3.012、4.6351，P<0.01或0.05）；亚急性期KD患儿LVMI、LCA内径仍较高，GLS及中间段纵向应变开始升高但仍较低，且差异均有统计学意义（t=4.786、4.387、4.895、4.031，P<0.01)。与KD患儿急性期比较，KD患儿亚急性期LVMI较低，GLS、基底段纵向应变、GCS及基底段环向应变均升高，且差异均有统计学意义（t=3.99、2.976、4.5362、4.428、5.327，P<0.01或0.05）。与冠状动脉正常组KD患儿比较，冠状动脉扩张组KD患儿CRP浓度、ESR、ALT浓度、AST浓度均升高，且差异均有统计学意义（t=3.127、P=0.003，t=928、P=0.006，t=3.201、P=0.003，t=3.174、P=0.004）。KD患儿急性期左心室GLS与LVMI、CRP均呈负相关（r=-0.795，P=0.000；r=-0.67，P=0.041）。 结论KD患儿急性期左心室心肌收缩功能降低，亚急性期开始恢复，恢复期至正常范围。二维斑点追踪技术是一项简单、能精确评估KD患儿不同时期左心室心肌功能的新方法，其能在常规超声心动图测得左心室收缩功能正常情况下早期发现KD患儿左心室心肌收缩功能异常，对辅助临床早期诊断KD、远期随访KD患儿左心室功能变化及降低冠状动脉损伤发生率有一定应用价值。

The study of left ventricular systolic function in Kawasaki disease evaluated by two dimensional speckle tracking imaging

ObjectiveTo assess the change of regional and global left ventricular (LV) myocardial systolic function in patients with Kawasaki disease (KD) in different phases by two-dimensional speckle tracking imaging (2DSTI) and analyze the correlation of systolic peak strain (S) and strain rate (SR) of LV with other conventional indices. Methods50 KD children in acute phase were enrolled as KD group, while 30 age and gender-matched children who had no cardiac abnormalities on echocardiography were included as control group from January 2016 to December 2016 in children hospital of Lanzhou university second hospital. The KD group were divided into coronary artery dilation (CAD) subgroup (n=12) and coronary artery normal (CAN) subgroup (n=38). Conventional echocardiography parameters, peak systolic LV myocardial regional and global S and SR were obtained using 2DSTI before intravenous immunoglobulin (IVIG) in the acute phase, 1 week after IVIG in the subacute phase, and 8 weeks after the onset of KD in the convalescent phase. The laboratory parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), platelet (PLT), alanine transaminase (ALT) and aspartatetransaminase (AST) were also acquired from KD patients in acute phase. The Comparisons on above parameters were made between controls and the KD group in different phases, and between CAD subgroup and CAN subgroup as well. The correlation of LV systolic global longitudinal strain (GLS) with conventional echocardiography parameters and laboratory parameters was analyzed. ResultsCompared with controls, The KD group had higher left ventricular mass index (LVMI), left coronary artery (LCA) diameter, right coronary artery (RCA) diameter and lower GLS, basal longitudinal S, middle longitudinal S, peak systolic global circumferential strain (GCS) and basal circumferential S (t=4.823, 4.123, 3.018, 3.982, 5.135, 4.753, 3.012, 4.6351 respectively, P<0.01 or 0.05) in acute phase. And LVMI, LCA diameter and lower GLS, middle longitudinal S remained at higher level in subacute phase (t=4.786, 4.387, 4.895, 4.031 respectively, P<0.01). But all indices recovered to normal level in convalescent phase. The LVMI in KD group decreased significantly and The GLS, basal longitudinal S, GCS and basal circumferential S increased remarkably in subacute phase compared with acute phase (t=3.99, 2.976, 4.5362, 4.428, 5.327, respectively, P<0.01 or 0.05). Compared with CAN subgroup, KD patients with CAD had higher ESR, CRP, ALT, and AST (t=3.127, P=0.003; t=928, P=0.006; t=3.201, P=0.003; t=3.174, P=0.004, respectively). The GLS was associated with LVMI and CRP negatively (r=-0.795, P=0.000; r=-0.67, P=0.041, respectively) in acute phase. ConclusionsThe LV longitudinal and circumferential systolic S significantly decreased during the acute phase of KD, improved immediately at subacute phase and continued to improve at the convalescent phase. 2DSTI was a simple and accurate approach in evaluating LV myocardium function during different phases of KD. Despite normal LV systolic function by routine echocardiographic measurements in acute phase, KD patients already had reduced LV systolic S which may be a more sensitive indicator of myocardial inflammation and may provide supportive criteria to avoid delayed diagnosis of KD. The CAD may not be a risk factor for LV dysfunction in acute phase. This new technology may provide clinician with valuable information on assistive diagnosis, guidance for drug use, long-term follow-up and reduction in the incidence of coronary artery lesions.